| NPI | 1326572157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T7073) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2021-01722) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2022-04-29 |